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Secondary Lymphedema of Both Lower Extremities Complicated with Pretibial Myxedema: A Case Report
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摘要: 本文报道一例罕见双下肢继发性淋巴水肿合并左胫前黏液性水肿患者，通过完善淋巴系统全面检查诊断为双下肢继发性淋巴水肿，对该患者左小腿肿物行部分切除活检术，初步诊断为纤维黏液性肿瘤(中间型)，倾向浅表CD34阳性纤维母细胞性肿瘤伴黏液变性，因肿物病变罕见，诊断过程中产生分歧，病理结果经国内多家医院会诊，结合病史以及激素治疗效果，最终确诊为左胫前黏液性水肿。外用卤米松软膏治疗10月余，结节全部变平，留有淡褐色色素沉着斑。本文就该疾病的鉴别诊断进行讨论，以提高临床医生对该疾病的认识。Abstract: This paper reports a case of rare secondary lymphedema with pretibial myxedema, which was diagnosed as secondary lymphedema of both lower extremities by completing a comprehensive examination of the lymphatic system. After partial resection and biopsy were performed on the tumor of the left lower leg, it was initially diagnosed as a fibromyxoid tumor (intermediate type), more likely superficial CD34-positive fibroblastic tumor with myxodegeneration. As the tumor of the left lower leg was rare, after consulting the opinions of some domestic hospitals, and combined with the medical history and hormone treatment effect, our final diagnosis was left anterior tibial myxedema. After more than 10 months of external treatment with halometasone ointment, all nodules became flat, leaving light brown pigmentation spots. This article discusses the differential diagnosis of this disease, with the aim to enhance clinical doctors' understanding of the disease.
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Key words:
- lymphedema /
- myxedema /
- pretibial myxedema
作者贡献：郝昆负责资料收集、文献整理及论文撰写；孙宇光负责文献整理及论文修订；李滨、信建峰、张丽、余春开负责影像及病理资料的整理及分析；王仁贵、沈文彬负责论文审校。利益冲突：所有作者均声明不存在利益冲突注：本研究发表已获得患者知情同意。 -
图 1 患者治疗前后腿部皮肤外观
A.治疗前左小腿前内外侧皮肤外观；B.卤米松乳膏涂抹患肢，保鲜膜包裹治疗4 d后肿块缩小，局部皮肤呈红色；C、D.治疗近3个月肿块消失，局部皮肤呈暗红色；E、F.治疗近10个月，皮肤平整，局部留有少量淡褐色色素沉着斑
图 3 患者核素淋巴显像示左下肢及右小腿继发性淋巴水肿
A.双足皮下注射显像剂10 min后影像，显像剂于左下肢皮下弥漫性分布(箭头)；B.注射显像剂1 h后影像；C.注射显像剂2 h后影像
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[1] 郝昆, 信建峰, 孙宇光, 等. 以下肢淋巴水肿为首发表现的恶性肿瘤的临床分析[J]. 中华医学杂志, 2022, 102: 584-587. [2] Ding L, Xu WJ, Tao XY, et al. Clinicopathological features of superficial CD34-positive fibroblastic tumor[J]. World J Clin Cases, 2021, 9: 2739-2750. doi: 10.12998/wjcc.v9.i12.2739 [3] 万良斌, 冯俊明, 曾英, 等. 浅表性CD34阳性的纤维母细胞肿瘤1例报道并文献复习[J]. 诊断病理学杂志, 2020, 27: 322-326. https://www.cnki.com.cn/Article/CJFDTOTAL-ZDBL202005009.htm [4] 庞俊伟, 闫攀攀, 马春花, 等. 浅表性CD34阳性纤维母细胞肿瘤1例并文献复习[J]. 临床与实验病理学杂志, 2018, 34: 909-911. https://www.cnki.com.cn/Article/CJFDTOTAL-LSBL201808022.htm [5] SendhilKumaran M, Dutta P, Sakia U, et al. Long-term follow-up and epidemiological trends in patients with pretibial myxedema: an 11-year study from a tertiary care center in northern India[J]. Int J Dermatol, 2015, 54: e280-e286. doi: 10.1111/ijd.12658 [6] Kim WB, Mistry N, Alavi A, et al. Pretibial Myxedema: Case Presentation and Review of Treatment Options[J]. Int J Low Extrem Wounds, 2014, 13: 152-154. doi: 10.1177/1534734614531485 [7] 邓武权, 吴绮楠, 姜友昭, 等. 局部免疫调节治疗甲状腺相关性胫前粘液水肿的临床观察[J]. 第三军医大学学报, 2011, 33: 2433-2434. https://www.cnki.com.cn/Article/CJFDTOTAL-DSDX201122031.htm [8] 齐书静. 胫前粘液性水肿的临床诊治[J]. 双足与保健, 2018, 27: 96-98. https://www.cnki.com.cn/Article/CJFDTOTAL-SZBJ201808060.htm [9] 谭芳, 余叶蓉. 胫前粘液性水肿的临床诊治[J]. 实用医院临床杂志, 2014, 11: 26-28. https://www.cnki.com.cn/Article/CJFDTOTAL-YYLC201401010.htm -
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